managing symptoms and behaviours of mental illness

As your family member begins and continues her recovery journey, she may exhibit negative symptoms and behaviours. There are ways you can help your family member to manage those symptoms.

It is important that you learn to accept your family member as she is now and make sure she is always treated with respect. You will need to separate the illness from the person.

Symptoms discussed on this page:

Depression

Gently encourage your family member to engage in activities and assume responsibilities she may have given up. Allow your family member to set the pace – even if it’s not as fast as you would like. Respect your family member’s emotional and physical limitations. She may need the rest to get well again. Getting outside and doing physical activity of any form often gives a sense of accomplishment and can boost self-confidence. Be sure to give positive feedback for all accomplishments, such as walking a block or to the neighbour’s home next door, even if you had hoped for more.

Hallucinations

When your family member seems to be hearing voices or sees things that you do not see, stay calm. Try to distract her by asking her to do something or by engaging her in conversation. If your family member is hearing voices more and more, this may be a sign of relapse. Encourage your family member to speak with her health professional(s). Do not pretend to see or hear what she hears, but acknowledge what she’s hearing, e.g., “I understand you hear another voice even though I don’t.”

Delusions

Delusions are firmly held false beliefs that can’t be changed simply by telling your family member that what she thinks isn’t true. It is pointless to argue with her. Acknowledge that you appreciate that your family member truly believes what she is saying, but don’t agree with it. It is better to help her with the distressing emotions she is feeling rather than to dispel the beliefs.

Any delusion is likely to be troubling to your family member and to you. Try to remain calm and reassure your family member. It is not uncommon for delusional beliefs to include family members. This type of delusion may be particularly troubling to you because others may think these beliefs are true.

The nature of some delusions may lead you to be concerned about your family member’s safety or well-being. It may be difficult to know what is true and what is not. As you work this through, it is usually helpful to verify “facts” with others.

“We made the mistake of pretending to agree with our daughter’s strange ideas. When she was well again, she was very distressed that we hadn’t been truthful and provided her with a reality check. After a family meeting with her doctor, my daughter decided to use us to check her think”ing and reality. It’s worked really well for us.

Manic behaviour

Manic behaviour patterns include hyperactivity, heightened mood to the point of elation, and overexcitement. If your family member begins to exhibit manic behaviour, try to be a calming influence. Try to slow things down (for example, talk more slowly, walk more slowly). Express your concerns about her actions but be prepared that she may not see anything wrong. Since manic behaviour can seriously affect the well-being of your whole family, set clear limits on behaviour and take action when warning signs begin to appear. A more common manic behaviour is impulsively spending money. Paying attention to spending patterns, credit card use and bank balances may help you to identify this behaviour early.

Social withdrawal (withdrawal from family, friends and activities)

Gently encourage your family member to participate in everyday family activities (eating meals, watching television), but be prepared for your family member to refuse. It may be difficult for your family member depending on her stage of recovery. Large family gatherings may be too overwhelming. Social contact outside the family is very important. Your family member may find peer support or other community-based supports helpful. Friends can also be an important source of social enjoyment.

Apathy/Lack of motivation

Ask your family member to help with simple tasks or chores and be sure to thank her when she does. You may say something like, “Thank you for helping me with the laundry. I enjoyed your company; it made the chore much easier.” Regular exercise and mental activity like going for a walk and reading the newspaper can also help.

It is important to move at a manageable pace. Pushing your family member to do too much too soon can be overwhelming and may add stress to her life. If she doesn’t want to join the family for dinner, suggest that she come for a short period or perhaps to get a plate and then leave to eat alone. Ask your family member what she feels she is able to do. While no small task for most, many families find that learning to appreciate very small steps and see them as significant accomplishments makes life just a little bit easier.

Aggressive behaviour

You don’t have to tolerate violent or aggressive behaviour. The first thing to do is assess the level of danger. If you feel your family’s safety is at immediate risk, call 911 for help. If you feel the situation is safe, try to find out why your family member is angry. The most effective way to calm a person is to encourage them to talk about their angry 48 Living With Mental Illness: A Guide For Family And Friends feelings. Ask your family member to explain what is upsetting her or making her angry.

Acknowledge your family member’s feelings with comments such as “I can see you are angry” or “I appreciate how you feel.” Try not to argue with your family member; it could make the situation worse. Be reassuring. If your family member makes reasonable requests that don’t put anyone in danger, try to go along with them.

Embarrassing behaviour

Clearly outline and reach an agreement with your family member about what behaviour is and is not acceptable.

Families have reported that a direct approach sometimes works well. Saying things like “Stop that,” or “Knock it off,” or “That’s inappropriate,” may change the behaviour.

Alcohol or other drug use

Mental illness and alcohol/drug use frequently occur together. Fifty per cent of people living with mental illness also experience a substance use problem. Many youth and young adults who develop mental illness begin to use alcohol and other drugs at some point in their life. They may use alcohol or drugs for a variety of reasons. Their reason may be to combat social anxiety, boredom or loneliness; block out symptoms or side-effects of medication; or because of a desire to fit in with friends, like any other youth.

People living with mental illness are more sensitive to the effects of alcohol and street drugs. Drugs and/or alcohol can interfere with the effectiveness of prescribed medications. They can also increase symptoms and risk of relapse. Use of drugs and/or alcohol is also linked to increased risk of violence. People who have mental illness and serious problems with substance use are said to have a concurrent disorder.

Alcohol or drug use is not an easy issue to deal with. While abstinence is the safest option, experts recognize that many people are unwilling or unable to completely abstain. The concept of harm reduction focuses on reducing the risks and consquences of harmful involvement with alcohol, other drugs and gambling. If you suspect your family member has an alcohol or drug use problem, talk with hre openly. If you accuse her, however, she is likely to automatically deny there is a problem. As a family member, you may be able to negotiate occasional use or an agreement to cut back. Encourage your family member to get help. Capital Health’s Addiction Prevention & Treatment Services (APTS) can be reached at 424-3263. Services for families are available from APTS even if your family member chooses not to seek services for herself. There is no cost for the services.

Studies estimate that:

Gambling

While anyone can develop gambling problems, people living with mental illness are at higher risk of developing problems if they start gambling. Problems with gambling can happen quickly or develop slowly. Many people believe gambling problems are due to a lack of willpower and self-control, but this is not true. The causes of gambling problems can be very complex. Some people gamble as a way of coping. Others may see gambling as a possible source of income. Whatever the reason or cause, it is important for people to get help. Unfortunately, many people with gambling problems feel embarrassed or ashamed and don’t often get help. If your family member is gambling and you are concerned, first talk with her. Try not to jump to conclusions. You may want to refer to the chapter about communication for tips on how to talk with your family member. If after you’ve talked with her and you are concerned she may have a gambling problem, you may want to talk with your family member’s health professional(s). Capital Health’s Addiction Prevention & Treatment Services (APTS) can be reached at 424-3263. Services for families are available from APTS even if your family member chooses not to seek services for herself. There is no cost for the services. Nova Scotia’s problem gambling help line is also available. Call 1-888-347-8888.